In 2004, I was working in a hospital in Kent when the sector-based approach was abandoned and the in-patient/out-patient way of working was launched. ^{Reference Laugharne and Pant1} This also coincided with the launching of a plethora of teams in the community. Each of these new teams was very clear of their exclusion criteria but a lot less clear about everything else.

Whenever I tried to question the evidence of this approach I ran the risk of being accused of impeding progress. It gradually came to me that this approach was not just the symptom of the malady of change for change's sake but of something far more sinister. It was borne out of a dislike of consultants. A manager actually blurted it out: ‘Your little empires are being demolished!’

I did the only thing I could do at the time. I fled as far away as I could from the influence of such half-baked ideas. I am happy to report that up here in the Highlands of Scotland things are still very traditional and they work much, much better.